Monica Gamez

1
Immunization Requirements Update

• Monica Gamez
• Immunization Compliance Coordinator
• Department of State Health Services
• Immunization Branch
• June 6, 2005

2
Overview

• Immunization Requirements Update
• Vaccine Requirements
• Frequently Asked Questions

3
Immunization Updates

• Texas Immunization Schedule proposed to DSHS
  Advisory Council
• Pending approval/adoption
• Possible statewide requirement for pneumococcal
  and hepatitis A vaccine for child-care facilities
• If signed by Gov., effective 9/1/05
• Rule change will follow for CCFs

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Highlights of Rules Changes

• Requirements by grade levels rather than age
• Additional dose of DTaP and IPV required
• Modifications to hepatitis A, hepatitis B, and
  varicella requirements
• Allowance of age ranges for child-care facility
  requirements

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Recommended or Required?

• Recommendations are for everyone
• Requirements are for children attending
  child-care facilities or school

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Source and Authority

• Recommendations are made by the CDCs Advisory
  Committee on Immunization Practices (ACIP), which
  has representatives of the American Academy of
  Pediatrics (AAP), and the American Academy of
  Family Practitioners (AAFP)
• Requirements are authorized by the Texas
  Education Code and Human Resources Code and are
  specified in 25 TAC 97.61-77 (Texas
  Administrative Code)

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Figure 25 TAC, 97.221
Page 1 of 2
Department of State Health Services Immunization
Schedule
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines for children through age 18
years. Any dose not given at the recommended age
should be given at any subsequent visit when
indicated and feasible. Indicates age
groups that warrant special effort to administer
those vaccines not previously given.
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5 Doses of DTaP Required

• Five doses at Kindergarten entry
• Pre-Kindergarten and other early childhood
  programs are required to follow the Texas
  Immunization Schedule
• 5th dose between 4-6 years of age
• Verification of 5th dose at kindergarten

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Frequently Asked Question

• Q On or after the 4th birthday is there any
  flexibility?
• A Yes. A dose of DTP or polio vaccine required
  on or after the 4th birthday may have been
  received up to four days before the 4th birthday.

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Frequently Asked Question

• Q Will students be grand fathered if they
  received four doses of DTP/DTaP/DT and Polio
  vaccines more than four days before age four?
• A Yes. Students in grades 1-12 will be grand
  fathered. However, any student entering
  Kindergarten will be required to have the dose
  on/or after the fourth birthday.

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Recommendation - Polio

• All IPV schedule at 2 months, 4 months, 6-18
  months, and a booster at 4-6 years
• OPV acceptable only in special circumstances
• Unvaccinated child traveling to polio-endemic
  area in lt 4 weeks
• Parents refuse additional injections (3rd and 4th
  dose only)

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Frequently Asked Question

• Q On or after the 4th birthday is there any
  flexibility?
• A Yes. A dose of DTP or polio vaccine required
  on or after the 4th birthday may have been
  received up to four days before the 4th birthday.

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Recommendation-Hepatitis A

• No statewide routine recommendation at this time
• Special recommendation for areas where hepatitis
  A incidence has exceeded 10 cases per 100,000 on
  average over a 10 year period

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Counties Requiring Hepatitis A
Counties that require hepatitis A vaccine for
entry into school or child-care
Newly added counties as of December
2003 Requirement effective August 1, 2005
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Recommendation - Varicella

• One dose of Varicella vaccine is recommended for
  children who are at least 12 months old and less
  than 13 years old who do not have a reliable
  history of chickenpox
• Two doses are recommended for students 13 years
  old or older without a reliable history of
  chickenpox

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Requirement - Varicella

• One dose on or after 1st birthday for the
  following grades
• 2004-05 K 4 and 7 10
• 2005-06 K 5 and 7 11
• 2006-07 K-12
• Two doses if vaccine given at 13 years of age or
  older

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Reliable Varicella History

• Written statement from a parent or guardian
• Written statement from a physician
• Written statement from a school nurse
• Serologic test result

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Recommendation - Hepatitis B

• At birth, 1-2 months, and 6-18 months OR 1-2
  months, 4 months, and 6-18 months
• Strategy Eliminating transmission through
  Universal Childhood Vaccination

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Requirement - Hepatitis B

• Three doses are required for the following grades
  in the following school years
• 2004-05 K 5 and 7 10
• 2005-06 K 11
• 2006-07 K 12

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Two-Dose Hepatitis B Vaccine

• Approved only for 11-15 year olds
• 2 (1.0 ml) doses given 4-6 months apart
• 1.0 ml Merck dose must be documented
• Children and adolescents who have begun
  vaccination with the three-dose series should
  complete the three-dose series
• If it is not clear which dose an adolescent was
  administered at the start of a series, the series
  should be completed with the three-dose schedule

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Recommendation - MMR

• MMR at 12-15 months and 4-6 years
• First MMR should not be administered before 12
  months of age

22
Requirement MMR/Measles

• Two doses of a measles-containing vaccine with
  the first dose on or after the first birthday
  second dose by age 5 or entry into kindergarten

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Frequently Asked Question

• Q On or after the first birthday is there any
  flexibility?
• A Yes. Up to four days prior to first
  birthday. Doses administered prior to September
  1, 1990 may have been administered in the
  calendar month of the first birthday.

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Recommendation - Hib

• Dose at 2 months, 4 months, and 6 months booster
  at 15 months of age
• If vaccination is begun later than recommended,
  the total number of doses required for complete
  vaccination may be fewer

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Requirement - Hib(Number of Doses)

• Age-appropriate vaccination
• Not required for kindergarten and above

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Frequently Asked Question

• Q Are there any exceptions to compliance?
• A Yes. Children and students may be excluded
  from compliance if a medical contraindication to
  vaccination exists, for reasons of conscience,
  including a religious belief, or if they are on
  active duty status in the United States Military.

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Medical Exemption

• Medical contraindications must be signed by an MD
  or DO licensed to practice in the U.S. The
  statement should indicate that it is the
  physicians opinion that the required
  immunization would be injurious to the health and
  well being of the child/student or a family
  household member.

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Frequently Asked Question

• Q What needs to be included in the Medical
  exemption?
• The medical contraindication exemption must
  specify the specific vaccination contraindicated.
• Unless a lifelong condition is specified, it is
  valid for one year from date signed and must be
  renewed annually.
• It does not have to be notarized.

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Conscientious Exemption

• Allows exemption for reasons of conscience,
  including a religious belief
• Applies to child-care facilities, elementary or
  secondary schools and institutions of higher
  education
• Student may be excluded in times of emergency or
  epidemic
• Requires affidavit

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Conscientious Exemption

• Requires written requests for affidavit,
  including facsimiles
• Requires full name and date of birth of child
• Allows request for up to five forms per child
• Allows exemption for one or more vaccines
• Affidavit form is valid for two years

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Conscientious Exemption Requests

• Current Data on Affidavit Requests
• (as of 6/3/2005)
• Number of forms sent out 35,721
• Number of requests received 6,497
• Number of children 10,799

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Who Do I Contact For More Information?
DSHS Immunization Branch 1100 West 49th Street,
Austin, Texas 78756 Monica Gamez, School
Immunization Compliance Coordinator Monica.Gamez_at_d
shs.state.tx.us [phone] www.ImmunizeTexas.
com
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QUESTIONS ?
www.ImmunizeTexas.com